Healthcare Provider Details

I. General information

NPI: 1124996996
Provider Name (Legal Business Name): TINA G GOODMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 LOCHMERE DR
MORRISTOWN TN
37814-2183
US

IV. Provider business mailing address

283 LOCHMERE DR
MORRISTOWN TN
37814-2183
US

V. Phone/Fax

Practice location:
  • Phone: 865-203-1416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number41368
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number263025
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: